There is an increasing recognition that psychological issues are a primary concern for cancer patients, both during and after treatment. Anxiety, depression, fear of recurrence and other psychological concerns need to be addressed to maintain quality of life.

Did you know?

Approximately half of all patients with cancer experience emotional difficulties.¹ 

Adjustment disorder is a common psychological complication, with individuals suffering from depressed mood, anxiety, lack of life satisfaction, hopelessness and/or loss of self-esteem.² 

Anxiety and distress are particularly prevalent among cancer patients. Psychological, social, and spiritual factors contribute to distress. In severe cases, it may interfere with the patient's ability to effectively manage the illness, its symptoms and the complications of treatment. 

Psychological issues may impact behaviours that are critical for cancer survivors.^3,4 Survivors who have clinical depression have a two times greater mortality risk from any cause, when compared to survivors who don’t have clinical depression.⁵ 

Research suggests that the emotional needs of cancer patients are not met as they should be. For example, one survey of bone marrow transplant survivors found that half of those who reported feeling distressed said they had not received treatment for their emotional needs.⁶ 

The Facts

Adjustment disorder

• Adjustment disorder can occur when someone goes through a stressful life event, including the diagnosis of cancer. It can be addressed through individual psychotherapy by teaching coping skills that focus on stressors caused by the disease. Cognitive therapy was found to be useful in reducing distress and increasing quality of life in patients with melanoma.⁷
• Patient support groups play an important role in helping cancer survivors to cope with the distress that often accompanies a diagnosis. Support groups include tumour‐specific or mixed groups, and may be either informally structured, meet at regular face‐to‐face meetings or be run by professionals who provide expert education and training.⁸
• A UK study found that the most common reasons people joined a cancer support group were to meet others like themselves (63.5%), find emotional support (13%) and get practical advice (8%).⁹ 

Anxiety

Anxiety is reported by about 18 to 25 percent of long-term cancer survivors.^10–14 Symptoms may include:

• Tension
• Restlessness or jitteriness
• Hypervigilance 
• Insomnia
• Distractibility
• Breathlessness
• Emotional indifference
• Apprehension and worry 

Management of Anxiety

• Anxiety in patients with cancer may be managed with a combination of psychotherapy, drug-free approaches and medications. While many symptoms may be seen as normal responses to a cancer diagnosis or treatment, symptoms that are severe enough to impair daily functioning or quality of life need further assessment and treatment.
• Drug-free interventions for anxiety and distress include psychotherapy and behavioral interventions, either alone or in combination.¹⁵ Interventions include:
• Supportive psychotherapy. This is a short-term, solution-oriented psychotherapy that focuses on a specific problem. It addresses both existential and crisis-related issues and may involve the patient and their family.¹⁵
• Behavioural interventions. A common behavioural intervention includes a relaxation exercise that combines passive or active muscle relaxation with deep breathing. There is evidence that progressive muscle relaxation may have benefits for patients undergoing chemotherapy.¹⁶ A study comparing progressive muscle relaxation and the anxiety drug, alprazolam, found that both were effective in relieving mild to moderate anxiety or distress in cancer patients.¹⁷ Patients with extreme anxiety may benefit from a combination of relaxation techniques and medications.
• Exercise. A program incorporating strength and aerobic exercise can help reduce anxiety, particularly in supervised training programs. Moderate-intensity aerobic training three times per week over at least a 12- week period, or a combination of aerobic plus resistance training twice weekly over a 6- to 12-week period, can substantially reduce anxiety in cancer survivors during and after treatment.¹⁸
• Stress management training. Watching a video or reading material that provides instructions on stress management techniques can be helpful in relieving psychological distress during treatment.¹⁹
• Creative Arts therapies. Engaging in art, dance, music and writing may offer cancer patients some relief from symptoms of depression and anxiety during treatment.²⁰ 

Management of Insomnia

• Some cancer patients experience anxiety as insomnia, and may benefit from cognitive-behavioural therapy (CBT). CBT focuses on challenging negative or faulty thoughts and behaviours, and developing healthier problem-solving skills to target difficult situations. A meta-analysis involving 752 cancer survivors with insomnia²¹ found that CBT improved sleep efficiency and reduced the severity of insomnia. 

Depression

Depression among patients with cancer may disrupt the process of treatment and recovery, ultimately impacting their overall health, wellbeing and mortality risk.²² Identifying depression and selecting the most suitable intervention are critical components of cancer care, with treatments ranging from brief counselling and support groups to medication and psychotherapy.²³

• Medications. These are usually prescribed for moderate to severe levels of depression. However, when compared to placebos, antidepressants for clinical depression in cancer patients do not appear to offer significant benefit. ²⁴
• Psychotherapy. Psychotherapy interventions are used to help people improve their coping skills. Individual and group therapies are beneficial for reducing depressive symptoms and distress while enhancing quality of life.²³ The benefits of psychotherapy are extensive for patients with advanced incurable cancer.^25,26
• Cognitive Behavioural Therapy (CBT). CBT helps patients overcome exaggerated fears by encouraging them to consider various outcomes for their situation. Focussing on aspects of the condition and its treatment that can be influenced or controlled, and supporting behaviour change that promotes involvement and optimism, may result in a better quality of life. These effects appear to be long-term, with patients reporting fewer depressive symptoms several years later.²⁷
• Support groups. Support groups are important for cancer patients and their families who are distressed.²⁸ Hospitals and community organisations often sponsor groups that are professionally run and/or offer self-help.
• Exercise. Moderate-intensity aerobic training three times per week over at least a 12-week period, or a combination of aerobic plus resistance training twice weekly over a 6- to 12-week period, can significantly reduce depressive symptoms in cancer survivors during and after treatment, particularly in supervised training programs.¹⁸ 
• Spiritual Interventions. Patients with cancer may experience reduced depression and anxiety and greater spiritual wellbeing and quality of life from interventions focussed on prayer, meditation and finding meaning and purpose.²⁹ 

 

What can we do about it

If you are currently experiencing anxiety or depression after a cancer diagnosis, don't put on a "happy face" if you don't really feel this way. Share your concerns with your cancer care team.

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Connect with people who will listen and can help with the practical aspects of dealing with cancer. Asking family members and loved ones for this kind of support may help you and the people who care about you feel better.

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Consult with your doctor before starting an exercise program. As much as possible, exercise regularly for at least 150 minutes per week at moderate intensity.

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To relieve anxiety and depression, experiment with behavioural techniques like deep breathing and progressive muscle relaxation.

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Engage in activities you really enjoy. Creative arts and music are good examples.

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See a clinical psychologist or counsellor.

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Take time for spiritual reflection and prayer.

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